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HMT MACHINE TOOLS LIMITED # 59, BELLARY ROAD, BANGALORE - 560 032.

(Please fill boxes in BLOCK LETTERS only)

Affix Photograph

APPLICATION FOR THE POST OF: 1 2 3 Name Mr. / Ms S/o, D/o, W/o Address for communication (with Pin Code)

Telephone No./s (STD code & Phone No.) Mobile Email Ids 1 2 4 Date of Birth D

Office

Residence

AGE (as on the date of application

Caste / Category

SC

ST

OBC

GEN

PH (Tick appropriate column)

Qualification (Copies of all Marks Cards & Degree certificates to be enclsoed) Year of Course Examination Passed Full /Part time Passing duration

University / Institution

Agg. % Marks

Specialisation

Post Qualification Experience: (Details of nature of duties may please be given as Annexure) Period (Commencing from latest /present) Organisation and Address Designation Nature of Duties From MM YY To MM YY Duration YY MM Pay & Pay Scale

Demand Draft No. Date .... Amount Rs Bank Certified that the information furnished above are true

Place Date

: :

Signature of the Candidate

STATEMENT OF DOCUMENTS ENCLOSED TO THE APPLICATION FORMAT:


Status (tick the relevant column) Yes 1 2 3.1 3.2 3.3 Demand Draft for the prescribed amount. Proof of date of birth (SSLC / Matriculation Marks Card) Proof of Caste SC/ST in the prescribed format) Latest OBC Certificate (Non creamy layer) in the format as applicable for appointment to posts under Govt of India to be produced. Ex-Servicemen Certificate PWD Certificate issued by the Competent Authority (Govt Hospital or Medical Board attached to Special Employment Exchange for the handicap) as per the Persons with Disabilities [Equal Opportunities, protection of right and full participation] Act, 1995. Qualification Certificates: SSLC / Matriculation Marks Card Degree Marks Card (Semester-wise / Year-wise) Degree Certificate PG Degree / Dip Marks Card (Semester-wise / Year-wise) PG Degree / Diploma Certificate Other Qualifications, if any (Please specify) Post-Qualification Experience Certificate (s) No NA

Sl. No.

Documents

3.4

4 4.1 4.2 4.3 4.4 4.5 4.6 4.7

Note : The attested copies of the documents / certificates should be enclosed to this format in the same order.

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